Jeffrey Lieberman got a few inches in the Grey Lady yesterday. It was an “untreated mental illness” lament, and we at Evidencer thank him for shifting the discourse from guns to mental illness, which is that much closer to the murderous side effects of chemopsychiatry, which we maintain are under-recognized. (Untreated mental illness is not.)

Well, have a look at his insertion if you didn’t catch it on Friday. Sputter and fume. I’ll be there on the other side with an open letter to Dr. Lieberman and an open bottle of Cazadores.

How to Halt the Violence

By JEFFREY A. LIEBERMAN AUG. 28, 2015

WHEN Vester Lee Flanagan II fatally shot a television reporter and a cameraman in the midst of a live interview in Moneta, Va., it was a scene that has become all too familiar to us.

In all these scenarios, we learn after the fact that the perpetrator has had a troubled past in which he exhibited bizarre and disruptive behavior, and frequently a history of diagnosed but untreated mental illness. The media and public erupt in outrage, but after the chest thumping and soul searching, nothing is ever done.

As a psychiatrist, I’ve treated thousands of patients with serious mental illness over my 30-year career and consulted on too many such criminal cases. I find it lamentable that we still cannot connect the dots and take effective action, as a vast majority of these tragedies are preventable.

A 2007 case that I was asked to review illustrates the problem. It involved an 18-year-old man, an athlete and a good student, who began with high hopes.

However, at the start of sophomore year, he quit the football team, left school and went home. At home he was withdrawn, disheveled, talked to himself and was suspicious of his friends and family. His parents knew something was wrong and sought treatment. When a mobile crisis team was called to the house he refused to engage with them. Although he clearly was ill, he was not aggressive, so they told his parents to continue monitoring their son’s behavior and to call if he became a threat to himself or others. The next day he stabbed his twin half-brothers with a kitchen knife, killing one of them and severely injuring the other.

Incidents like this are part of the glaring array of social pathologies that emanate from our country’s failed mental health care system. We need to identify mental illness early and intervene before the person’s symptoms disrupt their lives and society. One way to do this is to embed mental health professionals in emergency rooms and general medical clinics. Another, since many mental disorders begin in adolescence, is to train school personnel and guidance counselors and provide them with screening instruments and referral sources for mental health care.

The New York State Office of Mental Health was an early adopter of an innovative program called OnTrackNY. Similar programs are now spreading across the country and being supported by the federal government.

This model of mental health care targets adolescents and young adults in the incipient stages of psychotic disorders and establishes specialized clinics that provide “wraparound” services with pharmacological, psychological, educational and social-support treatments to engage patients and promote recovery.

For patients already at advanced stages and disabled by their mental illness, it is imperative that we make comprehensive services available to them. This includes medical management, psychotherapy, rehabilitation services and supervised residential facilities.

In many instances mentally disturbed people lack awareness of their illness, and are unwilling to accept treatment. Almost every mentally ill perpetrator of mass violence had been symptomatic and untreated for lengthy periods of time before their crime, because they (or their families) did not seek treatment or they refused it.

Statutory mechanisms like assisted outpatient treatment have been enacted in 45 states. They enable doctors to obtain a court order that requires severely mentally ill patients who meet certain legal criteria — — if they are unable to care for themselves or are unwilling to take medication — to adhere to treatment. However, these legal mechanisms are controversial and infrequently used despite their effectiveness in reducing violent incidents and hospital readmissions.

We are reluctant to infringe on people’s civil rights by forcing them to accept treatment, even though we do just that for communicable infectious diseases such as tuberculosis and various sexually transmitted diseases. But we must start using this law to treat patients in need, over their objections if necessary. This strategy would apply to a small number of people who have psychotic disorders, and known risk factors for violence, such as drug abuse and a history of violence.

The good news is that these strategies have proved highly effective and really work. They simply have not been widely applied.

Dear Jeffrey,

I’m looking for a fact here. Start with “a scene that has become all too familiar to us.” Traffic jams? Familiar. Neighbors walking dogs? Every day. Sun rising in the morning? At least every day.

But multi-victim shooting scenes? How many among 329 million US residents have seen one that wasn’t a cop shooting a kid in the back and the family pet for good measure?

And then this. Can this even be answered without Common Core training?: “In all shooting scenarios, do we often learn of untreated mental illness?”

No. We learn of treated mental illness, and no mainstream psychiatrist as has ever rebutted the claim that the vast majority of mass shooters are on or just off psych drugs and of the age and sex that’s most vulnerable to the mind- and mood- and reality- altering psych drugs that drive these God-awful events. One toe in that muddy water and you, Pies, Torrey? Just try it. Rebutt. Or just butt; this will be the first time. You’ve given Ritalin to worsen the symptoms of schizophrenia, and you refused to give it to your son,* so you know a thing or two about drugs. Take off the tu-tu and help us end this heartbreaking catastrophe and corporate crime.

James Holmes didn’t buy a weapon until he’d been in the care of psychiatrists for two months. The first purchases for his spree were gas masks, and he bought those after he’d been put on Zoloft. You read his diary and declared him to have been nothing more than “a confused, distressed, and troubled young adult.” That’s a bit of a quagmire; Holmes was not mentally ill, you say, but was treated for mental illness. If it wasn’t mental illness, did treatment cause his crime? By the way, the Marshall Report published your commentary on June 2. Seven days later, three jurors were dismissed for lying about exposure to media coverage of the trial. What coverage would that have been?

Then there’s your 2007 anecdote. Young man can’t hack college, comes home, doesn’t want to talk to anyone, isn’t violent. A “mobile crisis team” rolls up, creates a no-doubt humiliating experience for the man in front of his parents and siblings, and the next day, the non-violent man stabs both of his brothers with a weapon of convenience, killing one. If he’d been visited by Charles Manson the day before, we’d all blame Manson. Why is this crisis team not seen as a likely cause of the man’s first violent crime? I hate to ask, but did they give him a drug?

Now, what of “Incidents like this are part of the glaring array of social pathologies that emanate from our country’s failed mental health care system”? I’ll tell you what emanates. Experts like Lieberman and profound over-use of drugs like Zoloft, Paxil and Effexor. Killers like James Holmes emanate from those.

Why is a system staffed with psychiatrists and psychologists and reliant on FDA-approved drugs failing, anyway? In 2005, $135B per year was spent in mental health care. It’s hard to find more recent data, but projections in 2005 were that it could be $239B today. Sticking with the hard 2005 figure, that’s $18,750 per capita for everyone with schizophrenia and bipolar. Want a system that works? Spend the budget on rent and food for the severely mentally ill ($10,000 year), help with tasks of daily living ($6,000), and God forbid, some pocket money ($2,750). Sure, we’d have to set aside some funds for all the depressives on antidepressants, but generics are so cheap these days it’s a trivial cost.

What of this? “Almost every mentally ill perpetrator of mass violence had been symptomatic and untreated for lengthy periods of time before their crime.” I wish you’d given a source for that rough statistic, and the Whole Cloth Digest is not a valid one. I can’t find a mass killer that wasn’t in treatment.

Then you go on about the value of treating kids for psychosis before they are psychotic, the value of treating in general, and the necessity of forced treatment, all without giving evidence that they prevent violence. You wind down with…

The good news is that these strategies have proved highly effective and really work.

Effective and they really work. Saying something twice is not evidence. You close with…

They simply have not been widely applied.

For which we can think our lucky stars.

As ever,

Eve

*”I was following the interview with Dr. Lieberman with mild interest until he recounted the consultation with a paediatric psychiatrist concerning his son. He (meaning Dr. Lieberman) disagreed with the diagnosis of ADHD and declined a prescription for Ritalin. This may very well have had an admirable outcome for his son, but what of the other children in the care of the prescription-happy physician? Did Dr. Lieberman investigate this further – or was he just happy to have rescued his own child from unnecessary drug intervention?”
(listener comment on a 2015 radio interview)